Perspectives Of Nurse Practitioners Research Articles

Contrast Coverage: A Nurse Practitioner's Perspective

Contrast Coverage: A Nurse Practitioner's Perspective

SIR Annual Meeting 2023: A Nurse Practitioner's Perspective

SIR Annual Meeting 2023: A Nurse Practitioner's Perspective

Physician and nurse practitioner perspectives of a modified Routine Opioid Outcome Monitoring (ROOM) Tool.

Introduction The Routine Opioid Outcome Monitoring (ROOM) Tool was developed for use in community pharmacies in Australia. It facilitates pharmacists' screening and brief interventions regarding an individual's opioid use for chronic pain. At our academic teaching hospital, the ROOM Tool was adapted to incorporate a communication tool that includes a pharmacist's assessment and recommendations for primary care providers. This modified ROOM Tool was implemented as part of usual care in our outpatient pharmacies; however, the value to primary care providers is unknown. Aim The aim of this study was to determine primary care provider perspectives on the modified ROOM Tool. Methods Focus groups were conducted with primary care providers from an Academic Family Health Team. The focus group encompassed topics related to the positive and negative aspects of the modified ROOM Tool in supporting the care of patients using opioids for chronic pain. Qualitative content analysis of transcripts was performed to identify themes. Results Three focus groups were conducted with a total of six participants. Four themes emerged: (i) Facilitators to using the tool, (ii) Barriers to using the tool, (iii) Recommendations for improvement, (iv) Impact of the tool on patient care and safety. Discussion The ROOM Tool paired with the communication tool supports collaboration between pharmacists and primary care providers. The communication tool standardises the approach for communicating the pharmacist's assessment and recommendations. Recommendations to refine this modified ROOM Tool may increase its utility to primary care providers and enhance the impact on patient care and safety.

Effecting change and improving practice in a regional Emergency Department: A Mental Health Nurse Practitioner's perspective.

Providing appropriate, timely intervention and care to people who present with mental health issues to an Emergency Department presents unique ongoing challenges, often affecting patient experiences and outcomes. To address such concerns, a Mental Health Liaison Nurse role, led by a Mental Health Nurse Practitioner, was introduced to a regional Emergency Department. This role provided integrated emergency-based mental health clinical practice, with positive findings reported in a recently published multi-site translational research project. With sound quantitative and qualitative evidence detailing the benefits of this role, the experiential perspective from a clinician working in this frontline space further confirms the importance of having access to such a position in leading cultural and systemic change. This discussion article identifies key processes that align current research with the clinical perspective. Such processes recognize the challenges of implementing a new role and moving forward from these to embed consistent clinical practices. The need to build sound internal and external stakeholder partnerships, effect change implementation, and assign recommendations to ensure sustainability of improved practice and processes are highlighted in this paper. This article is, therefore, designed to assist other advanced practice nurses, who may be embarking on a similar journey and want to influence organizational policy and practice.

Care of Adults With Down Syndrome: The Nurse Practitioner Perspective

Down syndrome is a chromosomal disorder that is commonly diagnosed in childhood. The most referenced care guidelines need updating and focus on children. As a result of advancements in health care, life expectancies for people with Down syndrome have reached middle to late adulthood, leaving providers unprepared for the management of common comorbidities in adults with Down syndrome. To promote quality of life in this population, this overview of emerging recommendations and evidence-based literature through a systems-based approach may help nurse practitioners foster high-quality and cost-effective services in providing care for adults with Down syndrome.

The Essential Elements of Adolescent-friendly Care in School-based Health Centers: A Mixed Methods Study of the Perspectives of Nurse Practitioners and Adolescents

PurposeIn this study we identified the essential elements of adolescent-friendly care in school-based health centers (SBHCs) from the perspectives of the nurse practitioners (NPs) providing care to adolescents and the adolescents, as the consumers of these services. Design and methodsComplex adaptive systems provided the philosophical and theoretical foundation for this study. An explanatory sequential mixed methods study was conducted. A Delphi technique (strand one) was conducted with an expert panel of NPs (N = 21) to identify the essential elements of adolescent-friendly care in SBHCs. The second strand, a focus group study with adolescents (N = 30), elaborated on the Delphi results. Data from the two strands were then mixed. ResultsThis study generated expert opinion regarding the essential elements of adolescent-friendly health care in SBHCs. After four Delphi rounds, consensus was reached on 98-items (49% of the original 200; consensus level of 0.75). The results clustered into 6 essential elements: Confidentiality/Privacy (n = 8; 8.2%), Accessibility, (n = 15; 15.3%), Clinician/Staff (n = 51; 52%), SBHC Clinical Services (n = 12; 12.2%), SBHC Environment (n = 4; 4.1%), and Relationship between the School and SBHC (n = 8; 8.2%). The adolescent focus groups confirmed the essential elements identified in the Delphi and added two overarching themes: Comfortable and Trusted Relationship. ConclusionsThese findings contribute to a greater understanding of essential characteristics needed in adolescent friendly care. Practice implicationsSBHCs, as an important community resource for addressing the health care needs of adolescents, should incorporate these characteristics.

An Exploratory Analysis of US Nurse Practitioner Perspectives on Training and Credentialing

An Exploratory Analysis of US Nurse Practitioner Perspectives on Training and Credentialing

An Exploratory Analysis of US Nurse Practitioner Perspectives on Training and Credentialing.

Primary care is crucial as a foundation to healthcare in the United States, and has benefited from the increasing use of mid-level providers to achieve universal and quality primary healthcare. We investigated nurse pracitioners (NPs) as independent providers in primary care through a grounded theory study including interviews with both NPs and physicians. Subsequent content analysis revealed a spontaneous theme among NPs: a focus on current trends in advanced practice nurse education. Nurse practitioner (NP) participants voiced concerns regarding the amount of clinical training required for the NP degree in two areas: clinical experience requirements for applying to graduate nursing programs, and clinical experience in graduate programs before practicing as advanced practice nurses. Nursing education organizations should make as a priority gathering information on the perceptions and clinical needs of NPs in practice. This will aid in creating educational programs that graduate NPs ready to practice as independent primary care providers.

Cardiovascular outcome trials in type 2 diabetes: A nurse practitioner perspective

ABSTRACT To provide an overview of cardiovascular outcome trials (CVOT) with once-weekly glucagon-like peptide-1 receptor agonists (GLP-1RAs), and other recent CVOTs, and to discuss the implications for the management of patients with type 2 diabetes (T2D). Details of completed and ongoing CVOTs of glucose-lowering drugs from primary articles and ClinicalTrials.gov were collated and critically reviewed for information relating to patient populations and primary outcomes. Cardiovascular outcome trials have demonstrated the cardiovascular (CV) safety of a number of new glucose-lowering drugs. Recent trials suggest that some glucose-lowering drugs—including the once-weekly GLP-1RA semaglutide (post hoc analysis) and once-daily liraglutide—may reduce the risk of CV events in patients with T2D and high CV risk. Given their prime role in managing treatment choices for patients with T2D, nurse practitioners should strongly consider prescribing therapies, such as GLP-1RAs, that offer improved glycemic control, weight loss, a low risk of hypoglycemia, and beneficial CV outcomes.

Reflections on establishing a nurse practitioner role across acute hospital and home-based palliative care settings in Australia.

Nurse practitioners have been well-established in many parts of the world and valued as a senior role in healthcare systems. This paper offers an appraisal of a palliative care nurse practitioner model of care project and augments an understanding of being a nurse practitioner (NP) in the Australian context. To enhance outcomes for people regardless of care setting; and to enhance professional relationships between hospital and community services. A secondary objective was to facilitate a seamless transition from one service to another. The setting was a home-based palliative care service and a tertiary acute hospital, between which the role was employed. This paper describes the role from the NP's perspective, using the NP's log of work and personal reflections. Despite describing many challenges, an NP shared model of care has benefits not just for smoothing the client's journey through settings of care, but also for increased opportunities for clinicians to work together. There are opportunities for further research, including models of role implementation, the skills required by the clinician, and acceptance and respect of the NP role.

A Nurse Practitioner's Perspective on Prescribing Suboxone for Opioid Use Disorder.

A Nurse Practitioner's Perspective on Prescribing Suboxone for Opioid Use Disorder.

The Essential Elements of Adolescent-Friendly Care in School-Based Health Centers: A Mixed Methods Study of the Perspectives of Nurse Practitioners and Adolescents

Abstract Purpose In this study we identified the essential elements of adolescent-friendly care in school-based health centers (SBHCs) from the perspectives of the nurse practitioners (NPs) providing care to adolescents and the adolescents, as the consumers of these services. Design and methods Complex adaptive systems provided the philosophical and theoretical foundation for this study. An explanatory sequential mixed methods study was conducted. A Delphi technique (strand one) was conducted with an expert panel of NPs (N = 21) to identify the essential elements of adolescent-friendly care in SBHCs. The second strand, a focus group study with adolescents (N = 30), elaborated on the Delphi results. Data from the two strands were then mixed. Results This study generated expert opinion regarding the essential elements of adolescent-friendly health care in SBHCs. After four Delphi rounds, consensus was reached on 98-items (49% of the original 200; consensus level of 0.75). The results clustered into 6 essential elements: Confidentiality/Privacy (n = 8; 8.2%), Accessibility, (n = 15; 15.3%), Clinician/Staff (n = 51; 52%), SBHC Clinical Services (n = 12; 12.2%), SBHC Environment (n = 4; 4.1%), and Relationship between the School and SBHC (n = 8; 8.2%). The adolescent focus groups confirmed the essential elements identified in the Delphi and added two overarching themes: Comfortable and Trusted Relationship. Conclusions These findings contribute to a greater understanding of essential characteristics needed in adolescent friendly care. Practice implications SBHCs, as an important community resource for addressing the health care needs of adolescents, should incorporate these characteristics.

The “Eyes” Have It: Reviewing Keratoconus, the Nurse Practitioner Perspective

Abstract Keratoconus, a chronic, progressive ocular disease, is characterized by thinning and protrusion of the cornea. Etiology is not wholly understood; however, associations with heredity and environmental factors have been established. Keratoconic patients present with irregular astigmatism, diminishing visual acuity, and a continuous need to have prescriptive changes to spectacles and contact lenses. Keratoconus is a principal indicator for corneal transplantation. It affects both sexes and all races, beginning in adolescence. Nurse practitioners are uniquely positioned to interrupt the preventable contributors to keratoconus through assessment, prompt referral, and treatment of the physiologic and environmental factors linked to development and advancement.

Knowing Your Limits: A Qualitative Study of Physician and Nurse Practitioner Perspectives on NP Independence in Primary Care.

The shortage of primary care providers and the provisions of the Affordable Care Act (ACA) have spurred discussion about expanding the number, scope of practice (SOP), and independence of primary care nurse practitioners (NPs). Such discussions in the media and among professional organizations may insinuate that changes to the laws governing NP practice will engender acrimony between practicing physicians and NPs. However, we lack empirical, descriptive data on how practicing professionals view NP independence in primary care. The aim of the present study was to explore and describe the attitudes about NP independence among physicians and NPs working in primary care. A qualitative study based on the principles of grounded theory. Thirty primary care professionals in Missouri, USA, including 15 primary care physicians and 15 primary care NPs. Semi-structured, in-depth interviews, with data analysis guided by grounded theory. Participants had perspectives that were not well represented by professional organizations or the media. Physicians were supportive of a wide variety of NP roles and comfortable with high levels of NP independence and autonomy. Physicians and NPs described prerequisites to NP independence that were complementary. Physicians generally believed that NPs needed some association with physicians for patient safety, and NPs preferred having a physician readily accessible as needed. The theme "knowing your limits" was important to both NPs and physicians regarding NP independence, and has not been described previously in the literature. NP and physician views about NP practice in primary care are not as divergent as their representative professional organizations and the news media would suggest. The significant agreement among NPs and physicians, and some of the nuances of their perspectives, supports recommendations that may reduce the perceived acrimony surrounding discussions of NP independent practice in primary care.

A Case of Cognitive Impairment Presenting With Apraxia and Visual Disturbance: A Unique Nurse Practitioner Perspective

A 56-year-old woman developed problems with performing familiar tasks (apraxia), word finding (anomia), reading, and spatial orientation. The subsequent work-up and ultimate diagnosis illustrates the complex nature of cases being managed by doctorally prepared nurse practitioners.

Using an e-health intervention to enhance patient visits for hypertension: The nurse practitioner perspective

This article reports the findings from interviews with 11 nurse practitioners (NPs) who provided an in-office, e-health intervention as part of a randomized clinical trial aimed at improving medication adherence and reducing adverse self-medication behaviors in older adults with hypertension. The NPs’ perspective of their experience with training for the research protocol, recruitment of patient participants, implementing the e-health intervention, and patient response was elicited through open-ended questions in individual face-to-face tape recorded interviews.

Perspectives of Nurse Practitioners on Health Care Needs Among Latino Children and Families in the Rural Southeastern United States: A Pilot Study

IntroductionThe purpose of this study was to explore perspectives of nurse practitioners on health care needs among Latino children and families in the rural Southeastern United States. MethodThis qualitative research used semi-structured interviews with seven nurse practitioners (NPs) practicing in the rural southeastern part of North Carolina. Flanagan’s critical incident technique was used to describe the experiences of NPs providing health care for Latino children and parents. ResultsData analysis indicates that the most commonly reported illnesses by Latino children are upper respiratory infections and asthma, followed by otitis media, obesity, anemia, pneumonia, leukemia, and tumors. Barriers to health care for children included language and cultural differences, lack of access to care (e.g., lack of insurance, cost, and transportation), and health illiteracy/low education level of parents. The findings also suggest that Latinos are preserving their traditional health practices when treating their children’s illnesses, such as through use of foods, hot/cold items, herbs, coin on “belly button,” traditional juices, healing bracelets, and evil eye. DiscussionThe findings of the study imply the need to incorporate culturally sensitive care when providing care for Latino children and parents.

Improving cardiovascular health with motivational interviewing: A nurse practitioner perspective

The purpose of this article is to provide nurse practitioners (NPs) with an evidence-based counseling strategy for motivating patients to adopt healthier cardiovascular lifestyles and reduce their cardiovascular disease (CVD) risk. A comprehensive overview of motivational interviewing (MI), framed within the context of the transtheoretical model of change (TTM), demonstrates how primary care NPs can utilize this counseling approach to optimize cardiovascular outcomes in their patients. Published original research and review articles in scholarly journals on the following topics: MI; advice giving; counseling techniques; TTM; CVD; quality NP care. Although the major risk factors for CVD are largely preventable, CVD rates are increasing to epidemic proportions. Traditional advice giving to decrease CVD risk is minimally effective. MI combined with TTM is an effective counseling technique, which motivates patients who are resistant and ambivalent to change. MI is an appropriate, evidence-based strategy to promote cardiovascular health. NPs working in primary care can integrate MI with TTM into ongoing patient encounters to facilitate positive behavior changes in their patients over time. Thus, NPs can play a key role in decreasing the growing burden of CVD in North America.

Examining the Diverse Perspectives of Nurse Practitioners Regarding Obstacles to Diaphragm Prescription: A Latent Class Analysis

The diaphragm is receiving renewed attention not only for its dual method potential but also because of improved design. To facilitate method re-introduction, we examined what providers think about this female-controlled barrier contraceptive. A questionnaire administered to 450 women's health nurse practitioners (NPs) asked about their practice experience and issues concerning diaphragm use. Latent class analysis (LCA) was used to identify different groups of providers, based on patterns of perceptions regarding various potential obstacles to diaphragm use. Provider profiles were further described in terms of individual and practice characteristics. The survey achieved a 47% response rate (n = 214). Respondents saw, on average, 31 family planning patients/week; 87% had fitted a diaphragm, although only 40% had done so in the previous year. Three groups holding significantly different perceptions of obstacles to diaphragm prescription were identified. Group 1 (13% of respondents), with more practice experience in delivering women's healthcare and fitting diaphragms, considered all obstacles relatively inconsequential. Group 2 (40%) had comparatively minor concerns, whereas Group 3 (47%) perceived all issues as major obstacles. All groups stressed the diaphragm's limited promotion, and for 87% of the respondents, concerns about effectiveness and nonfamiliarity with the method also assumed more salience. Emerging statistical modeling approaches that go beyond standard aggregate analyses helped identify three groups of women's health nurse practitioners. By considering their diverse perceptions of potential obstacles to diaphragm use, strategies aimed at changing provider behaviors may be developed to reverse declining prescribing rates and retain the diaphragm as a viable reproductive healthcare option for women.

Integrating nurse practitioners into Canadian emergency departments: a qualitative study of barriers and recommendations

The objective of this study was to identify the facilitators and barriers associated with integrating nurse practitioners (NPs) into Canadian emergency departments (EDs) from the perspectives of NPs and ED staff. We conducted 24 semi-structured interviews with key multidisciplinary stakeholders in 6 Ontario EDs to gain a broad range of perspectives on implementation issues. Data were analyzed using a grounded-theory approach. Qualitative analysis of the interview data revealed 3 major issues associated with NP implementation: organizational context, role clarity and NP recruitment. Organizational context refers to the environment an NP enters and involves issues related to the ED culture, physician reimbursement system and patient volume. Role clarity refers to understanding the NP's function in the ED. Recruitment issues are associated with attracting and retaining NPs to work in EDs. Examples of each issue using respondent's own words are provided. Our study identified 3 issues that illustrate the complex issues involved when implementing NPs in EDs. The findings may inform policy makers and health care professionals in the future development of the role of NPs in Canadian EDs.